title: [Challenge of the management of severe trauma of cervical spine in sub-developed country].
abstract: OBJECTIVE
  The management of cervical spine injuries requires a multidisciplinary approach based on emergency management and rehabilitation. In our context this chain fails, especially on the post-hospital care. Our goal is to explain the difficulties we had in the management of these patients in Dakar.
  
  
  METHODS
  This retrospective cohort study (2005-2009) included 99 patients admitted for severe cervical spinal cord injury in two hospitals in Dakar. The clinical signs, treatment and outcome were studied. The follow up was between 3 and 54 months.
  
  
  RESULTS
  The average age of patients was 36.1 years and the traffic accidents were the main etiology (73.7%). Medical transport of patients was done in 65.7% with an admission average time of 64.86 hours. On admission, 57.6% of patients had Frankel score A or B. Dislocations (59.6%) and Tear drop fractures (16.2%) were the main lesions. The surgery was performed in 83.8% with a mean interval of 128.84 hours after the trauma. Outpatient rehabilitation was offered whatever the patient's neurological status. Recovery was complete in 20.2% and partial in 31.3% with a mortality rate of 37.4%. Most deaths occurred between 1 and 6 months (59.5%) mainly due to decubitus complications (56.8%).
  
  
  CONCLUSIONS
  The efficacy of the management of severe spinal cord injuries is based on reducing the preoperative time and rehabilitation.
authors.affiliation: Clinique neurochirurgicale, CHU de Fann, avenue Cheikh Anta Diop, BP 5035, Dakar-Fann, Sénégal. kpelas77@yahoo.fr
authors.forename: E
authors.initials: E
authors.lastname: Kpelao
authors.forename: A
authors.initials: A
authors.lastname: Diop
authors.forename: K
authors.initials: K
authors.lastname: Beketi
authors.forename: I
authors.initials: I
authors.lastname: Tine
authors.forename: M
authors.initials: M
authors.lastname: Thioub
authors.forename: A B
authors.initials: AB
authors.lastname: Thiam
authors.forename: M C
authors.initials: MC
authors.lastname: Ba
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002574:Cervical Vertebrae / Q000293:injuries* / Q000473:pathology; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000473:pathology / Q000628:therapy; D006801:Humans; D004204:Joint Dislocations / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000209:etiology; D012189:Retrospective Studies; D012675:Senegal / Q000453:epidemiology; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy*; D014187:Transportation of Patients; D016896:Treatment Outcome; D055815:Young Adult
keywords: Nursing; Outcome; Rehabilitation; Rééducation; Soins; Spinal cord injury; Traumatisme médullaire; Évolution